Employee Benefit Insights

​Prescription drug costs are rising faster than any other part of healthcare spending. A growing number of Americans can't afford their medications, forcing too many people to skip dosages - or skip taking their medication entirely - and become sicker.

Sick employees are making a significant and costly impact to organizations in terms of diminished productivity, quality, and attention to safety… and the vicious cycle goes on and on.

But why such a dramatic increase in drug costs?

There is an increasing number of new and innovative pharmaceutical products to help combat complex illnesses, and pharmaceutical companies will continue to drive the price until competition exists. Exclusivity terms (or patent rights) for brand drugs sometimes help fend off competition up to 20 years, let alone the projected volume of new prescription drugs that will hit the marketplace in future years.

But maybe it’s not just the drug company anymore?

Pharmacy Benefit Managers (PBMs) administer prescription drug plans for more than 266 million Americans who have health insurance. Though PBMs claim to have their plan members best interests at heart, here is a different view on a big driver you might not suspect, and how your PBM might be misaligned with the objectives of your group health plan.

In this 11-minute video, PBS News Hour provides some insight and different perspectives on how the PBM industry has evolved into a powerful player on the distribution of health benefits to your employees.

Employers should make sure their contracted PBM is working towards the best interests of their health plan members. If you are a partially self-insured employer or considering moving away from a fully insured program with a carrier, partnering with a quality and transparent PBM will lead to the most cost-effective benefit for your workforce.​​G. Scot Grooms, President/CEO